Journal of Perinatology最新文献

Despite growing concerns about the adverse effects of painful procedures in neonates, current guidelines continue to recommend using total serum bilirubin (TSB) levels to make decisions in the treatment of hyperbilirubinemia. Transcutaneous bilirubin assessment (TcB) has been studied extensively, but its presumed reliability is only based on how well it correlates with TSB. This assumes that TSB is the "gold standard" for determining the risk of bilirubin-induced neurotoxicity, although there is no direct evidence linking specific TSB levels to that risk. Furthermore, TSB levels are subject to variability due to the margin of error of the laboratory analysis. TcBs avoid skin-breaking procedures and have the additional advantages of decreased turn-around time, nursing and laboratory staff time, and costs. TcB procedures could be standardized, and new guidelines with increased reliance on them could significantly reduce painful procedures in these patients without increasing the risk of bilirubin neurotoxicity.

Perinatal transition is uniquely complex in newborns with critical congenital heart disease (CCHD), whose cardiopulmonary physiology often diverges from the standard neonatal resuscitation framework. We developed lesion-specific clinical practice guidelines (CPGs) for delivery room (DR) management of six high-risk CCHD diagnoses - hypoplastic left heart syndrome, dextro- transposition of the great arteries, Ebstein anomaly, congenital complete heart block, total anomalous pulmonary venous return, and tetralogy of Fallot with absent pulmonary valve. Developed collaboratively between neonatologists, cardiologists, and cardiac intensivists, these guidelines standardize DR stabilization for high-risk, low frequency events, promote a shared mental model among multidisciplinary teams, and provide structured escalation thresholds for oxygen, respiratory support, intubation, and medication use. Beyond clinical standardization, these CPGs enhance provider education, team preparedness, and family counseling. They offer a scalable framework adaptable to centers with or without on-site cardiac care, bridging physiologic principles with practical implementation.

Objective: Test the effect of thickened liquids on preterm infants (25-35 weeks of gestation) who are struggling to achieve full oral feeds.

Study design: Retrospective case-control study of preterm infants struggling to achieve full oral feeds at term, prompting provision of thickened liquids without aspiration on instrumental assessment, and controls, matched for gestational age and comorbidities, who followed a typical thin liquid feeding progression. Paired t-tests were used to test differences in overall milk transfer (%, milk consumed/prescribed) before and after thickening, with mixed linear regression to test differences between the control and thickened group.

Result: 38 infants (19 thickened) were included. Prior to thickening, infants struggling with feeds had significantly slower rates of improvement in overall transfer than controls (struggling feeders, 1.3%/day; controls, 4.5%/day) (p < .001). Overall transfer increased 13% 48 h after thickening (p = 0.01).

Conclusion: Thickened liquids may be an effective treatment for select preterm infants who are not progressing to full oral feeds at term postmenstrual age, even if aspiration is not observed on instrumental assessment.

Skin-to-skin care (SSC) significantly decreases mortality and improves preterm infants' outcomes. The World Health Organization recommends that every preterm baby receive 8-24 h per day of SSC beginning as soon as possible after birth but in many settings this goal is rarely met. An important barrier for SSC is parent availability; lack of parental leave, siblings who require care, and other factors often limit parents' availability for SSC. In many studies that demonstrated the benefits of SSC, including infection rate reduction, both parents and surrogates participated in SSC. Though not as ideal as parental SSC, surrogate SSC can be compared to donor human milk which does not provide all benefits of mother's own milk but is considered superior to formula. An analogous benefit could be true for infants who receive less than recommended parental SSC if surrogates support parents in providing extended periods of SSC.

Objective: To evaluate how the risk of unexpected newborn complications among term births varied by time of birth for 12.4 million full-term singleton births in the United States.

Study design: A population-based nationwide study. Exposures included time of birth, divided into four shifts and 42 distributed 4-h intervals. Logistic regression estimated the variations in the risk of unexpected newborn complications.

Result: The risk of unexpected newborn complications was higher during night shifts (OR 1.13, 95% CI: 1.12-1.14) and on weekends than on day shifts and weekdays. The risk of seizures and a 5-min Apgar score ≤3 increased steadily at the start of day shifts (07:00), while the risks of transfer, assisted ventilation ≥6 h, and neonatal death remained stable during day shifts. All outcomes increased during night shifts, peaking between 23:00 and 06:59.

Conclusion: Unexpected newborn complications were more frequent during night shifts and weekends, particularly between 23:00 and 06:59.

Background: BPD, ROP, brain injury (severe IVH or PVL), NEC, and sepsis are independently associated with neurodevelopmental impairment (NDI).

Objectives: Evaluate the contribution of BPD, ROP, brain injury, NEC, and sepsis, individually or in combination with BPD, on NDI at 18-24 months corrected age (CA).

Methods: Demographic, NICU, and follow-up data from infants born ≤32 weeks gestational age with a birth weight <1500 grams were collected. NDI at 18-24 months CA was defined as blindness, deafness, or a composite score of <85 on the BSID-III. Univariate testing and logistic regression models were used.

Results: Univariate analysis revealed a significant association between moderate and severe BPD, brain injury, NEC, and ROP with NDI. Logistic regression showed infants with brain injury or NEC had significantly greater odds of developing NDI.

Conclusions: BPD with brain injury or NEC increases the risk of NDI. Infants with ≥3 comorbidities had significantly higher odds of NDI.

Objective: Delirium is an increasingly recognized diagnosis in neonatal intensive care unit (NICU) patients. Infants with grade 3 bronchopulmonary dysplasia (BPD) may be at high risk of delirium due to prolonged mechanical ventilation, critical illness, and polypharmacy, including various neurosedatives.

Study design: We conducted a national survey to explore clinicians' knowledge, attitudes, and perceptions of delirium in term-corrected infants with grade 3 BPD.

Result: Over 60% of responders screened infants for delirium and initiated non-pharmacologic and pharmacologic interventions. Most participants agreed that delirium is under-recognized but felt uncomfortable diagnosing it.

Conclusion: This highlights the urgent need for research to establish the incidence of delirium in infants with BPD and associated outcomes, educate NICU clinicians, validate screening tools in the NICU setting, and develop comprehensive interventions to prevent and treat delirium in this vulnerable population.

Objective: Point-of-care (POC) testing offers expedited results with lower blood volume requirements than central laboratory (CL) tests, particularly for low-birth-weight infants.

Methods: A retrospective cohort included 118 patients with paired POC and CL tests within one hour in the first 14 postnatal days. Differences and agreement were assessed using linear mixed-effect models that account for within and between-subject variations.

Results: Compared to CL, POC testing underestimated sodium (6.0 mEq/L), potassium (0.1 mEq/L), chloride (5.1 mEq/L), and glucose (2.3 mg/dL), and overestimated hemoglobin (0.08 g/dL) and hematocrit (0.8%). Differences (CL- POC) varied by postnatal age and sample type, with larger differences for sodium and chloride that decreased with age and smaller differences in capillary and venous than arterial samples. Glucose and hemoglobin differences increased over time, while hematocrit remained stable.

Conclusions: POC results underestimated sodium, potassium, chloride, and glucose, and overestimated hemoglobin and hematocrit.

Background: Subgaleal hemorrhage (SGH) in neonates ranges from benign bleeds to life-threatening shock. Even small SGH may be linked with parenchymal brain injury and hypoxic-ischemic insult. This study aimed to characterize clinical and neuroimaging features of SGH and identify predictors of early abnormal outcomes or death.

Methods: We retrospectively reviewed all SGH cases admitted to a high-volume Dallas NICU over 11 years, where forceps are exclusively used for operative vaginal deliveries. Data included demographics, clinical and laboratory findings, neuroimaging, and outcomes. Severe outcome was defined as abnormal neurologic exam at discharge, seizures, encephalopathy, or death.

Results: Among 141,448 live births, 43 neonates required further care in the NICU for SGH (approximate incidence: 3 per 10,000 live births). Of these, two infants died, and 23% experienced severe outcomes. Volume expansion and metabolic acidosis predicted severity. MRI identified additional lesions not evident on ultrasound.

Conclusions: SGH requiring NICU care may signal broader neurologic injury. MRI aids diagnosis, while exclusive forceps use was associated with lower SGH incidence and mortality.